Does Valve Sparing Always Require Another Surgery Later?

[cbdheartman]

Thanks to those who have responded to my previous post -- and please keep the responses coming!

One question I had about the valve-sparing surgery is a discrepancy between what I was hearing on that thread and what the surgeon told me. When we spoke he thought based on my echo reports (he hadn't seen an actual echo film) that a) he could do valve sparing surgery and b) he thought there was an upwards of 50% chance that I would never need surgery again. Is there truly that sort of possibility especially if the valve is working fairly well right now?

 

[Reddog]

Repeat surgeries for Valve Sparing

Repeat surgeries for Valve Sparing

Here is my limited understanding... others should chime in to indicate whether I have it right. Bicuspid aortic valves tend to get stenotic early. The current belief is that the different mechanics of bicuspid valves cause extra wear and tear which produces calcium deposits and a stenotic valve as you age. The traditional time for this becoming an issue is in your 60's - but there's some variation there.

I've heard that there has been some evidence that some bicuspid aortic valves can last longer, but there's not a whole lot of data on this. I have one of the best repair surgeons around, and he thought that he could get 15-25 years more out of my 46 year old bicuspid aortic valve. I think there's a possibility that the repair could last forever, but I believe the odds are against it (though maybe they will develop drugs at some point to prevent the stenosis... though they haven't made much progress on this yet.)

So my understanding is that a bicuspid aortic repair will likely require additional surgery down the road. In some ways, I think of the repair as a great alternative to a tissue valve when possible. Tissue valves will last a very short time for young folks like you. In contrast, a repair could last 30-40 years or maybe even longer. Both avoid coumadin. However, if you're happy taking coumadin you can get a single surgery solution with a mechanical valve.

Please, others chime in if your understanding is different than mine (or the same!).

Also - please ask your cardiologist / surgeon your precise question. He could very well have information that I don't, and I'd really appreciate the opportunity to learn more or be corrected. If bicuspid repairs could last forever, I'd be very pleased indeed... that just contradicts what I've been told.

Best of luck,
Red

 

[Ross]

It's one of those, "Ask the Crystal Ball" questions. No one really knows, but most all repairs fail at some point. Some fail right away, others 7 to 10 years down the road, some never do.

 

[Tom F.]

What is the cause of your surgery? Originally the David type valve sparring procedure was intended to be used when the patient had an ascending aortic aneurysm and an otherwise normal aortic valve. That is the key, normal, and not bicuspid. If you have an aneurysm and a normal valve a David type repair typically shows good longevity. That is what I had done, and now 6 years out both my surgeon and cardiologist expect I will not need another surgery. Now if you are talking about a repair of a bicuspid valve you are entering somewhat new ground. Dr. David has been repairing some of these with good success, others are copying his work, but the jury is out as to whether they will last. There just is not the track record yet.

 

[cbdheartman]

Tom F.,

I have an aneurysm in my aortic root. I also have a bicuspid aortic valve with mild to moderate regurgitation and no stenosis.